MEDICARE: COURTNEY JEAN UPPENDAHL LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1558796854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY JEAN UPPENDAHL LMFT

Provider Business Mailing Address
First Line	:	PO BOX 1312
Second Line	:
City	:	EL DORADO
State	:	CA
Zip	:	95623-1312
Country	:	US
Telephone Number	:	530-497-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 1312
Second Line	:
City	:	EL DORADO
State	:	CA
Zip	:	95623-1312
Country	:	US
Telephone Number	:	530-497-0909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	04/04/2024

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